Provider Demographics
NPI:1336471762
Name:PIERCE, DERRICK KEVIN (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:KEVIN
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-0004
Mailing Address - Country:US
Mailing Address - Phone:518-963-4082
Mailing Address - Fax:
Practice Address - Street 1:1954 SARANAC AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1139
Practice Address - Country:US
Practice Address - Phone:518-523-2011
Practice Address - Fax:518-523-1933
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist